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Some tough questions for Roxon and Dutton at today’s election health debate

Will Health Minister Nicola Roxon and her Opposition counterpart Peter Dutton get a chance to talk about health and health policy at the National Press Club debate today, or will they (and the journalists attending) be stuck on political point-scoring and a hospital beds bidding war?

What questions should the journalists be asking to try and encourage a more useful health debate?

Crikey Health and Medical Panel Members have some suggestions….

Bob Wells, Menzies Centre for Health Policy, ANU

Two questions for both:
1.      Do the parties realise that Australia has one of the highest per capita rates of hospitalisation in the developed world yet both continue to prop up that sector at the expense of primary care and prevention? Given the overwhelming evidence that a strong primary health care system is needed to deal with the dominant health needs of the ageing and those suffering from chronic diseases, including mental health, what further plans do the parties have for primary care into the future, given that those on the table are comparatively modest in the light of the findings of the National Health and Hospitals Reform Commission and the Primary Health Care Strategy Task Force?

2.      Can the parties explain how a proliferation of new ‘local networks’ or ‘hospital boards’ layered over the existing fractured Commonwealth/states arrangements will reduce the ‘blame game’ and result in clearer accountability for health service delivery?

***

Fran Baum, professor of public health, Flinders University

Evidence (from the WHO Commission on the Social Determinants of Health and many other reviews and reports) indicates that the biggest impact on the health of a nation are the broader social determinants of health (rather than health services) and that governments need a concerted approach to determine how the policies of each sector either contributes or detracts from health and well-being. Will your government take action to address the social determinants through action such as the Health in all Policies approach of the South Australian Government and the European Union?

***

Professor Andrew Tonkin, Monash University

Although Australia has a high quality health system, in relative terms, health inequalities between the disadvantaged and advantaged continue to increase. What specific strategies would you implement to redress this situation?”

***

Gawaine Powell Davies, CEO, UNSW Research Centre for Primary Health Care and Equity

What do you plan to do about the increasing out of pocket costs to consumers for Medicare and privately funded health care?
Medicare funds are spent disproportionately in areas where GPs and private allied health providers choose to practice. How do you intend to ensure that people from other areas get their fair share of government funding for health care?

***

John Mendoza, mental health advocate

To Roxon – You have repeatedly stated “that there is more work to do in mental health”. Tony Abbott when Health Minister in 2005 at the time of the release of Not for Service report said exactly those same words. Labor in Opposition attacked him  for not committing to any real action. Your funding commitment to early psychosis centres will take 80 years to fully develop a national system. Are you serious about making mental health a second term priority and if you were why not commit to a 4-5 year rollout of headspace and early psychosis?

To Dutton. Your commitment to build early psychosis and headspace services has won high praise. But those same people have called for investment in services for those with severe and persistent mental illness, new accountability, new governance and a real 10 year plan to end the crisis in mental health. What will you do as health Minister to address these concerns?

To both of them. The 4 Corners program ‘Hidden Voices’ exposed the massive gap between needs for mental health care and the availability and quality of care in one boom community Mackay. This picture of massive unmet need is one repeated across the country. How will need the continuing cycle of crisis that surrounds mental health in Australia?

***

Professor David Penington, University of Melbourne

Q. for Dutton
1) I note that the Coalition intends for e-health to be implemented in due course, building on long standing planning.  With IT moving so fast, why is it not supporting the additional expenditure to bring it to fruition?

2)The statement of special support for teaching hospitals and for research in hospitals is welcomed, as is the commitment to medical involvement in hospital management. These are all welcomed as important for an evolving health system responding to knew knowledge and opportunities. Are you confident State Labor Governments will implement these initiatives?

Q for Roxon
In Kevin Rudd’s 3 March Press Club presentation about the LHN, he emphasised that medical people would be involved in management and governance of the LHNs, responding to the observations of Garling and many others on hospital visits about the distancing of doctors from management and their role in sucuring clinical standards. This, together with support for clinical research within university linked teaching hospitals, disappeared from the plans following the COAG decisions.  Could this be rescued?

***

A/ Prof Marilyn Wise, University of NSW:

What measures will you use to assess the success of the nation’s investment in health over the next five years?  How will you judge the success of the work of the health sector?

What actions is government taking to ensure that the eight-year difference in life expectancy between low income and high income Australians is closing?

In what ways are you engaging Aboriginal and Torres Strait Islander people in making decisions about investment in action to improve their health?

***

Wendy Oakes, public health advocate

The question I would like asked is: is the Coalition intending to scrap the Primary Health Care reform strategy altogether, or is it just being delayed to fund the new mental health services?

If it is being scrapped, what plans do they have to fix the current deficiencies in chronic disease management in primary care?

***

Professor Mark Harris, Executive Director Centre for Primary Health Care and Equity

1. Are they committed to a model of primary care for this century with e-health records, broadband that allows MRI scans to be viewed remotely, and multiple providers to work together to manage patients with chronic disease?

2. How are they committed to prevention? – both for the population through measures to reduce smoking and alcohol consumption and encouraging betters use of preventive care.

3. Dutton: does he really think a little extra funding for a Medicare item will really make a difference to access to after-hours care when younger GPs are increasingly reluctant to work afterhours?

4. Roxon: If community health services including early childhood and front line mental health services are not included in Medicare Locals how is this an advance on the current structure?

***

Stephen Leeder, Director of the Menzies Centre for Health Policy, University of Sydney

What are they proposing to do about out of pocket expenses?

***

Prue Power, Executive Director, Australian Healthcare & Hospitals Association

Dental
Q to both Roxon and Dutton
Given the significant detrimental impact of poor oral and dental health on the health of the population and the lengthy waiting times for public dental health, could you please explain the absence of policies to rectify this?

Indigenous
Q to both Roxon and Dutton
Given the significant gap in health outcomes between Indigenous and white populations in Australia, could you please explain the absence of policies to rectify this?

Integration and coordination
Dutton
Why is the Coalition is ignoring the position of almost every health stakeholder group and moving away from a more integrated health system, via the NHHN, towards further entrenching the isolation of hospitals from other sectors of health care?

Roxon
How does the Government, if reelected, intend to ensure integration and coordination between Local Hospital Networks and Medicare Locals and in particularly, to preserve the many existing innovations across Australia. Many people are despairing about how their coordination and integration projects will now be funded with the split between hospitals and Primary health/Community Care.

Independent Hospital Pricing Authority
Roxon
The role of the IHPA will be absolutely critical to maintaining a sustainable partnership between the Commonwealth and states/territories and in ensuring the confidence of the health sector.  Given the importance of its role and the fact that it will need to build infrastructure, expertise and critical relationships with stakeholders (eg AIHW, National Performance Authority, state/territory bodies), why is its establishment being delayed until July 2011, which only gives it one year to be fully operational?

***

Kim Webber, Chief Executive Officer, Rural Health Workforce Australia

Can anyone explain where the workforce will come from to staff these extra hospital beds?

***

Rob Loblay, medical specialist, University of Sydney

Question for both candidates:

Regarding giving autonomy back to local hospital boards with community & medical staff representatives:

1.       What will prevent local boards from making parochial spending decisions based on their desire to have the latest expensive whizz-bangery, or to enhance their status, or to satisfy some vocal board member’s wishes (hobby-horse/axe-to-grind/special interest), rather than fitting in with a more rational program of planned regional resource allocation?

2.       What will happen when local boards exceed their annual budget allocations before the end of the year (as will inevitably happen) – who will decide what services to close when the money runs out; who will be accountable; and who will come to the rescue? What will stop the minister from yielding to community/media pressure in marginal electorates & making ex-gratia allocations based on political whim/expediency?

3.       Aren’t we just putting the deck chairs back where they used to be a decade or so ago without fixing any underlying structural problems?

***

Carole Taylor, CRANA plus

What specifically are both parties doing for remote health
Dutton – What policies are in place to ensure the sustainability of the non GP workforce especially as it pertains to remote health
Dutton – what use is the expansion of hospital beds to the remote sector
Dutton – what are the strategies for improving indigenous remote health
Both – is there any intention of looking at retention issues for the non GP remote workforce

***

Professor Ian Olver, Cancer Council Australia

Our major question is:

Is either side of politics going to commit to urgently needed funding to maintain the integrity of the National Bowel Cancer Screening Program, which was a 2004 bipartisan election commitment, and also ensure it is expanded in the next term?

Funding for the piecemeal program runs out at the end of this financial year, yet neither side of politics has announced a commitment for its continuation, let alone the expansion so urgently needed for the program to reach its potential to reduce bowel cancer mortality and morbidity.

The phasing in of the program was a 2004 election commitment from both sides. Almost six years later, it is still only available once-off to people turning 50, 55 and 65 (and there’s no certainty that will continue given the conspicuous silence). By contrast, within five years of a whole-of-government agreement to introduce breast cancer screening, the BreastScreen Australia program was fully implemented.

***

Associate Professor Ngiare Brown, University of Sydney

Will Aboriginal and Torres Strait Islander health equality be a priority and how will Indigenous leadership and participation in policy, resourcing and delivery be guaranteed?

***

Margo Saunders, public health policy consultant

To borrow mercilessly from yesterday’s piece by Boyd Swinburn:

Most of Australia’s disease burden is driven by preventable risk factors, yet prevention is virtually nowhere to be seen in this election campaign.  While the message on mental health seems to be getting through, and plain packaging on cigarettes is a welcome move, there is still a prevention policy vacuum.

Where are the plans to implement serious policies on obesity, alcohol and tobacco, as outlined by the Preventative Health Taskforce?  The blueprint is there for a Government to take the opportunity for leadership in prevention by implementing the Taskforce’s recommendations.  The alternative is to continue to give corporations the upper hand when it comes to advertising, promotion and marketing, leaving the health system to pick up the pieces and bear the mounting costs.  These would be popular moves: public support for regulations to ban junk food marketing to children is far higher than it was for smoke-free environments when that legislation was first enacted.

It is not good enough for the current Government to say that these matters will be referred to a National Preventive Health Agency.   And it is not good enough for the Liberal Party to simply argue that ‘individual choice’ and ‘parental responsibility’ are the answers to obvious market failures. The fact that the legislation to create a prevention agency has not been enacted – and the fact that the agency, as currently construed, would have no regulatory powers – means that the key drivers of preventable ill health are languishing in a no-man’s land, somewhere between ‘wait and see’ and ‘not my problem’.

There was a vision:  In February 2006, Julia Gillard gave a speech in this room, entitled ‘Prevention is the Cure’, which focused on ‘the need for a health system with prevention at its core and the health of children at its very heart’. In June 2007, Labor released the paper, ‘Fresh Ideas, Future Economy’ which included a commitment to a national preventative health strategy. Much of the resulting strategy has rightly focused on primary prevention rather than the health care system.

Can you describe the plans that you have for prevention policies — without mentioning the words ‘hospital’ or ‘super-clinic’?

***

Caroline Homer, Professor of Midwifery University of Technology Sydney

To Both: Much of the current hospital reform proposed and legislated by the Government and now being implemented in states and territories focuses on acute services. Where is the funding and incentives for primary health and preventative health? What will the opposition do in relation to strengthening primary care?

To Mr Dutton: The Government has supported expanding the health workforce and has supported nurse practitioners and midwives in relation to MBS and PBS access. What is the Oppositions plans in relation to strengthening the non-medical workforce? How will the Opposition negotiate with the AMA to ensure reforms in this area are possible?

To Ms Roxon: Dental health and mental health have been largely forgotten in this current term despite big promises. What will the government really do this time around to enable access for all to these critical services?

***

Justine Caines, Homebirth Australia

Can you please explain how the common law rights of women can be maintained when you have instituted a determination that gives doctors veto power over both a woman’s decisions and midwifery practice under Medicare.

***

Chris Rissel, public health expert, University of Sydney

How will high quality health promotion (not just running health education groups) be implemented in the new local hospital networks?

How will the upstream social determinants of health be addressed by small local hospital networks?

***

Professor Mike Daube, Public Health Association of Australia

1.         Will all parties commit to implementing plain packaging of cigarettes, as recommended by all key health authorities, and opposed by the international tobacco industry?

2.         Is it appropriate that only 2.2% of national health spend goes to prevention?

3.         Will reading Croakey be a required condition of service for all Federal public servants?

***

Professor Gavin Frost, Acting Dean School of Medicine Sydney, University of Notre Dame Australia

Does the (new) government propose to increase funding to proven preventive programs?
And by how much?

***

Dr Mark Ragg, public health publisher

For Roxon:

Why has mental health been left off so many policy issues surrounding prevention?

For both:

Indigenous health is getting more funds and it is seen as a priority in some areas of government. But why not try doubling the funding and seeing if that makes the breakthrough necessary?

***

Fiona Armstrong, health reform advocate

Roxon:

How will the Medicare Locals interface with hospital networks and to what extent will this structure address gaps in continuity of care between acute and primary health care?

Will the government abandon the unpopular, expensive and ineffective GP Superclinics if it wins another term?

Dutton:

Given the reform process has been in train for several years now, what will a Coalition government do to introduce its own health policies given the agreements already made at COAG regarding the National Health and Hospitals Network?

Both:

What will a new Labor/Coalition government do to address the ongoing appalling health outcomes for Aboriginal and Torres Strait Islander Australians?

***

Carol Bennett, Consumers Health Forum

To both health leaders:

‘There has been a lot talk about consumer involvement in health reform, what would you do to ensure consumers have a real say in health decision making beyond the rhetoric of ‘consumers at the centre of healthcare’.

To Peter Dutton:

‘Will the Coalition spell out a detailed e-health policy before the election?’

***

Caroline de Costa, obstetrician and gynaecologist, Cairns

Abortion law is state law. The fact that this law was originally in the criminal legislation of all states and territories and has been reformed in variable degrees in only some of them means that access to abortion is very difficult for women in some states  and in rural and remote parts of the country. Equal access to essential health services is an underlying principle of our provision of health care in Australia. Are you prepared to initiate moves to bring about uniform abortion law and services for all Australian women?” or words to that effect. Regards, Caroline

***

Geoff Munro, National Policy Manager, Australian Drug Foundation

Given that the National Drug and Alcohol Research Centre reported this week that alcohol abuse is rising among young men and women, what practical steps other than ‘education’ will you take in government to reverse this growing national problem of binge drinking?”

***

Sarah Jaggard, Community Mobilisation Policy Officer, Australian Drug Foundation

How do they intend protecting children from exposure to alcohol advertising?

What do they intend doing about alcohol  taxation?

Where do they stand on alcohol health advisory labelling?

If elected, where does the Coalition stand on the recommendations regarding alcohol of the Preventative Health Taskforce?

Why has there been no commitment from Roxon to push secondary supply of alcohol to minors, given the issue has been sitting with COAG for a few years?

Given the recent data about an increase in hospital presentations from alcohol-related injuries, isn’t it better for the Coalition to invest in the problem rather that just increase the number of hospital beds?

Apparently Roxon under her Primary Health Care plans is proposing to close Divisions of General Practice in their present set up from 2012, and roll them out again in very reduced numbers from 2012 under the title of Medicare Locals under Primary Health care. She will reduce numbers from currently approx 109 Div of General Practice to 56 under her new set up.  Is it her intention considering the very tight time frame to still have 15 ‘Medicare locals’ – new name of Divisons – up and running by 1 July 2011, and if not when does she propose new date would be?  And what would Dutton be proposing if they were in power?

***

Anonymous

The coalition initiative to fund an increase in mental health is laudable, however to call it “new money” is clearly misleading as it is to come from savings in an already lean health budget. It is just a change in priorities, nothing more than that. Where exactly from the health budget does the coalition plan to find $1b in savings to pay for mental health. What is low enough on the coalition’s priority list that they can cut it by that huge amount?

***

Professor Drew Dawson, Director, Centre for Sleep Research, University of South Australia

Patient safety remains a significant and continuing cause of adverse patient outcomes in Australia and a significant opportunity for cost effective improvements in the delivery of health care. What specific initiatives are you intending to implement in order to improve patient safety.

***

Sebastian Rosenberg, Brain and Mind Research Institute, University of Sydney

About the biggest funding commitments made by Liberal and Labor in the course of this election in regards to mental health has been the establishment of new sub-acute mental health beds.  The Liberals have promised 800 new mental health beds, to be split between acute and sub-acute. Labor has promised 1300 new sub-acute beds, to be split between rehabilitation, palliative care and mental health.

What is the evidence base for this type of mental health care?  What existing services are you attempting to replicate or build?  With acute wards bursting at the seams, what is to stop these new sub-acute services becoming merely overflow warehouses, devoid of therapeutic intent?

This question or something like it needs to be asked because there is scant evidence to justify sub-acute mental health care and a massive capital investment is being made here instead of into a range of evidence-based community-based alternatives.

Also, please find attached a link to a paper I have just done for the Mental Illness Fellowship of Australia on the state of mental health research in Australia.

***

Loretta Marron, former Sceptic of the Year

The present Government wants to ensure that decisions on health management (including diagnostic and treatment options) are based on sound clinical evidence and not driven by financial incentives or other promotional influences and have set up a working party to look at this.

With the explosion of poor health information on the internet, does your Government share the same concerns in relation to both therapeutic goods and services?

***

Dennis Pashen, Associate Professor, Director, Mt Isa Centre for Rural and Remote Health, James Cook University

I’d ask Dutton his plans re the Health Reform Agenda, in particular about national accreditation and COAG reforms.

I’d ask Roxon about the lack of enthusiasm amongst GPs for the government’s roll out of the Superclinics and the emergence of the corporates, many of whom have little interest in teaching students and Registrars in bidding for the clinics. What will be the governmental approach to ensuring that GP workforce capacity is improved by these clinics?

***

Pharmacy consultant Ron Batagol

Question to Peter Dutton:

Given that most experts in the field are skeptical of the likely success and proactive involvement of all stakeholders with the Federal Government driving the proposed e-health programme, do the  Liberals have a plan to enable us to move towards a viable e-health programme, perhaps driven by industry expertise,  that will achieve its objectives and  is embraced by all major stakeholders?

***

Professor Alex Wodak, Australian Drug Law Reform Foundation

1 Will you implement the alcohol tax reforms in the Henry tax review?

2 Specifically do you support a volumetric alcohol tax with some hypothecation to prevention and treatment of alcohol and drug problems?

3 Do you support an increase in supported accommodation, mainly for geriatrics, mental health and alcohol and drugs, to increase the efficiency of our hospital system so that people who are too sick for the community but too well for hospital can be accommodated more appropriately?

4 Will you support a ‘whatever it takes’ approach to reduce the problem of obesity in Australia – including restricting advertising of energy dense foods to children?

5 Do you think donations from the tobacco industry to political parties should be banned?

6 Do you accept that the War Against Drugs has failed?

7 Should illicit drugs be regarded as primarily a health and social problem (with some support from drug law enforcement)?

***

Liz Wilkes, National Spokesperson, Australian Private Midwives Association

Women’s rights to choice in birth care have been stripped away by legislation requiring midwives to have care plans signed off by a doctor before women can get a Medicare payment for private midwifery care. How can both the ALP and Coalition justify supporting this AMA requirement ahead of women’s rights?  Does this mean that the AMA rather than government elected members are controlling health care in this country?

***

Hannah Dahlen, President of the Australian College of Midwives

How are midwives going to to be able to meet the requirements of the collaboration arrangement Determination (arrangement with a doctor) and provide care to women under the proposed reforms when not one has been able to date to find a doctor willing to enter into such an arrangement? These reforms are about to fall flat on their face.

***

Mary Chiarella, Professor of Nursing, Sydney Nursing School, University of Sydney

A commitment to primary health care is the only real way that hospital waiting lists can be reduced and hospital overcrowding addressed. The call for a commitment to primary health care, not just primary care, has been made by the World Health Organisation. What can either side of government promise to demonstrate that commitment?

***

David Briggs, editor of the Asia Pacific Journal of Health Management

At the State level it would appear that many are proposing health networks much larger than originally planned by Rudd. This means that community engagement and management at the local level will not be effectively addressed. As Minister for Health what steps will you be taking to ensure that these key elements of the reform are restored? As opposition spokesman on health what steps would you take to restore these balances if elected to govern?’

***

Terry Slevin, Cancer Council WA

What is the future of the national Bowel Cancer Screening program ?

***

Professor Gavin Mooney, health economist, University of Sydney

What are you going to do to foster a whole of government approach to the social determinants of health?

Will you set up a series of citizens’ juries to find out what the people of Australia want from the health care system?

***
Dr Michael Vagg, a physician in Victoria

With central opioid prescribing registries a proven means for reducing abuse and diversion of prescription painkillers overseas, what will they do to end the current absued situation whereby the the federally-run PBS is prevented (apparently by Commonwealth privacy legislation) from sharing information about opioid scripts with the relevant State government bodies which are charged with monitoring these medications? Why is this proven model of regulatory oversight not being implemented in Australia by either party when the infrastructure already exists to dramatically improve the quality of care for chronic pain patients and reduce the current harm from abuse and diversion of prescription drugs?

Secondly, what will either party do to implement the National Pain Strategy which was endorsed by an unprecedented consensus of healthcare, industry and consumer organizations in March this year?

***
Dr Trevor Beard, Menzies Research Institute, Hobart

When the European Parliament had traffic light labels ready for legislation in June it allowed the food industry lobby to give traffic lights a crushing defeat.

If Labor is returned, will Labor let that happen when Australia legislates on food labels early next year?

Comments 4

  1. Jackson Harding says:

    Nicola Roxon has just been banging on about how committed the Government is to reducing tobacco use and how (as we all know) that there is no safe level of tobacco use. As a medical practitioner I applaud her sentiments.

    Despite all the hype why then does the Government still subsidise the purchase of tobacco at the border? The duty free allowance on tobacco products granted to inbound travellers is nothing more than a slap in the face for those attempting to limit the harm tobacco does. Despite repeated letters to both Roxon and the Minister for Home Affairs on this issue I have only ever got one reply, a boilerplate reply from some low level flunky on behalf of Minister Roxon. To actually do something about it is simple, it requires no legislation, just a simple regulatory change to reduce the amount of tobacco allowed to zero.

    Jackson Harding

  2. ron batagol says:

    Just watched the debate. Unless I missed something, next to nothing about Aged Care and nothing at all about e-health! How come these important issues weren’t raised or debated?

  3. Jenny Haines says:

    It would be hard in one question and answer session to cover all of the problems in the health system, there are so many and they are so complex. Then there is the questions that arise out of the proposed restructuring. But some questions (other than those proposed by Prue Power) would be:
    1.Given that whichever party wins government, we are likely to move towards a national health system, largely Federally funded, what guarantees do voters have that such restructuring will improve the quality of services and patient outcomes? We will still have shortages of doctors and nurses ( at least for some years to come). We will still have shortages of beds. We will still have long surgical waiting lists.So what guarantees are there that after all of the restructuring involved, that there will be a better system and better outcomes?
    Rationale for this question: Having been through endless restructuring of the health system in NSW and having heard endless promises of improvement, we are still facing huge problems. Why is the proposed national health reform any different?
    2.We need to get the balance right between community based services, hospital beds and health promotion in terms of meeting people’s need for service and in terms of the appropriate services being available at the right time.There seems to be a difference between the statements of politicians on what the balance should be between these services, and what available funding allows. That difference seems to be based on the hopefulness of a Health Minister versus the economic rationalism of Treasury. What priorities would you as Health Minister place on each of these services and can you forsee that Treasury in your government will support those priorities?

  4. midwife says:

    Julia along with other women on Emily’s List Australia http://www.emilyslist.org.au/our-women categorically state that they believe in:
    “Choice…We believe women must have control over their own bodies and choices in their lives. Reproductive Freedom empowers women and men to choose if, when and how to begin the important journey into parenthood, without fear of discrimination, coercion or violence.” If the members of Emily’s List Australia genuinely believe that “women must have control over their own bodies and choices” then why at the 11th hour in the last Parliamentary sitting did Emily’s List support Nicola Roxon to remove the rights of pregnant women by the ‘sneaky’ passing of the Determination that veto’s every pregnant woman’s from having control over body and choice in her reproductive life. This sneaky passing of the Determination also enforced veto of Midwives professional autonomy to practice the full scope of their qualifications. What does this mean? It means all pregnant women are now forced to employ a doctor to make decisions for them, decisions about their place of birth and who their maternity service provider will be.

    Why – Julia, Tanya, Penny and Jenny when you are promoted as the four leaders of Emily’s List have you unequivocally agreed that every woman must be ‘signed off’ with the agreement of a doctor for the woman to be able to receive Medicare through the services of a Midwife? Why is your word and publicly recorded ‘belief’ incongruent with your political decisions making? Why are you preventing Australian women from employing a midwife to birth at home? What Julia’s are Mr Dutton’s responses to this discrimination?

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